Dan Windham

Winter is a particularly busy time for the NHS but, despite the rising numbers in A&E, Harrogate Hospital say they are in a strong position to cope with the pressure.

The latest figures for October, published by NHS England, has revealed that under 93 per cent of patients were seen in four hours, short of the 95 per cent national standard.

Harrogate is also starting to feel the pressure of winter with 4,593 patients visiting their A&E department in October, 101 more than in September.

Despite boasting a higher percentage than the national average, the hospital just missed out on hitting the guideline amount of patients admitted under four hours in both months.

However, chief operating officer Robert Harrison, believes the hospital is in a much stronger position this year to deal with the added strain compared to last year.

He said: “We go through this increased demand most years so it’s not a surprise. We experience a much higher level of emergency demand and in general it tends to be patients much sicker than at other times of the year.

“A lot of those patients are elderly who need support and admitting into hospital but the number of patients in A&E is not actually that different over winter.

Challenging

“It’s the people that need to be admitted into hospital which gets higher but we are in a much better place this year than we were last year.

“The increase in A&E attendances does impact on our performance against the guideline of under four hours. It’s very challenging but we always aim to deliver the national standard of 95 per cent.”

Mr Harrison explained that robust plans have been put in place to deal with the demand, including investing £50,000 in the A&E department and £50,000 in acute medicines.

However, services at the hospital could be hampered over winter by a shortage of nurses after Mr Harrison admitted they were struggling to recruit registered nurses.

Monthly reports filed by NHS hospitals showed that 207 of the 225 acute hospitals in England have been unable to find enough nurses to staff their wards.

This is a significant decline on performance last year and, with just one nurse for 22 patients in some hospitals, the figures have fuelled fears of an NHS winter crisis.

“Generally, throughout the organisation we have a robust plan to have good staffing to make sure we cope with the additional demand but it has been difficult recruiting nurses,” Mr Harrison said.

“We put these plans in place to have rota staff on all the wards but we have had to recruit additional core support workers and agency staff to support the wards.

“Our matrons manage this on a daily basis to ensure we deliver that quality level of service.

“It’s a daily challenge and the matrons have to work hard to make sure they’re fully staffed.

“It’s a national issue at the moment having registered nurses; again we are better than most places but it is still a challenge.”

In March this year, Harrogate was chosen as one of 29 ‘vanguard’ sites in England to trail a new look NHS healthcare provision which includes more health care at home and greater links between health and social care.

Mr Harrison said the new system was essential for combating the added pressure on the NHS and reducing the number of patients taking up beds in the hospital.

More than £2million has been spent since 2010 on hospital beds for patients at the hospital who have been well enough to go home.

The number of days lost to so-called ‘bed blocking’ has been steadily increasing with 335 bed days lost in Harrogate in October usually due to inadequate local social care.

These patients are prevented from leaving hospital and are left waiting for a care home place, or care at home packages which could lead to a detrimental impact on their health.

Hopeful

Mr Harrison is hopeful that by working closely with local partners, as a vanguard site, they will be able to safely discharge more of these patients and reduce overcrowding at the hospital.

He said: “The number of patients who are still occupying beds but are well enough to be moved on for other patients is too high. We have done a lot of work on improving our flow of moving patients through the system and that has delivered real benefits.

“So while October was one of our busiest ever months in terms of emergencies, we actually had a lower bed occupancy than in previous months because of managing the acute flow of patients.

“We have managed to reduce the number of patients in a bed by strengthening our resources of acute medicines to set up for their recovery despite seeing more patients overall.

“We need to continue utilising resources appropriately and minimising patients in hospital because there are some that don’t need to be there.”

The danger of overcrowding at the hospital comes against the backdrop of a nationwide funding crisis in social care.

As part of the autumn statement, George Osborne said local authorities can raise council tax by up to 2 per cent as long as the money is spent on social care.

Mr Harrison said plans had already been put in place for the future to keep the rising elderly population in their homes and out of hospital in the future.”

As part of their vanguard programme, the hospital has begun running local community services as well as working closely with North Yorkshire County Council to prevent people needing to enter hospital.

Whilst the hospital is not yet in full delivery of the programme, Mr Harrison explained that the system should keep residents at home for longer and the cost of social care down.

He said: “Part of the vanguard system is how we use it in the community to work with people at home to prevent them getting ill and coming to hospital.

“Our working relationship with organisations like the CCG and Harrogate Borough Council has developed well over the year and we are now starting to see the benefits.

“Whilst we are really busy and we have some escalation beds open, it’s significantly down from last year.

“Last year we had 27 open but today we only have four.

“The investment is there in our community services to keep people at home for longer which then reduces the amount of people moving into longer term care, costing a significant amount in social care.”